We have shown that transesophageal dobutamine stress echocardiography is a safe and reliable method for the assessment of patients with coronary artery disease. Accordingly, we sought to determine whether patients with chest pain and normal coronary arteries have similar evidence of myocardial ischemia during dobutamine stress assessed by means of transesophageal echocardiography. To this end, we studied 43 patients with chest pain and normal coronary angiograms (13 men age 49q10 years), 13 of whom had ischemic-appearing electrocardiographic responses to treadmill exercise. We also performed the same technique in 62 patients with coronary artery disease and in 21 normal volunteers. Dobutamine stress induced chest pain in 84% of patients with chest pain and normal coronary arteries, in 50% of coronary artery diseased patients, and in none of the normal volunteers. Ischemic-appearing electrocardiographic changes developed in 28% of patients with chest pain and normal coronary arteries, in 51% of patients with coronary artery disease, and in only 5% of the normal volunteers. Wall motion abnormalities occurred in none of the patients with chest pain and normal coronary arteries, in 89% of the patients with coronary artery disease and in none of the normal volunteers. Hence, in spite of the successful provocation of typical chest pain and/or electrocardiographic changes, patients with chest pain and normal coronary arteries did not have evidence of myocardial ischemia during transesophageal dobutamine stress echocardiography. Therefore, this technique appears as a useful and safe method for the identification of patients with chest pain of nonischemic origin.